What to Do About the Quillivant XR Shortage?

You will likely want to stay on something similar though, which will mean another long acting stimulant with methylphenidate, such as Aptensio XR, Concerta (Methylphenidate ER), Cotempla XR-ODT, Daytrana (patch), or Quillichew ER (chewable tablet). Metadate CD, Metadate ER, and Ritalin LA are other forms of methylphenidate, but they only last about 8 to 10 hours vs the 10 to 12 hours of all of those other long acting ADHD medications. Focalin XR (dexmethylphenidate) would likely be another alternative.

Unfortunately, there are no other liquid forms of methylphenidate. Except for Concerta and Metadate CD, you can open and sprinkle the contents of these capsules on applesauce if your child can’t/won’t swallow pills though.

You can also try and teach your child to swallow pills…

Best Alternatives To Quillivant XR

In reality, you probably don’t have that many options.

Your child is likely taking Quillivant XR because he couldn’t learn how to swallow pills, won’t take medications if you open and sprinkle them on things, and didn’t tolerate Daytrana (the methylphenidate patch).

That still leaves you with a couple of good options, including:

Quillichew ER – a chewable form of methylphenidate available in 20mg, 30mg, and 40mg chewable tablets (was under backorder, but that seems to have been resolved)

Cotempla XR-ODT – an oral disintegrating tablet form of methylphenidate available in 8.6mg, 17.3mg, and 25.9mg tablets

The main difference between all of the different forms of methylphenidate?

Surprisingly, it’s not only if it is a liquid, capsule, or pill. They all have different time release mechanisms that affect how your kids get the medication.

Quillivant XR, for example, uses a 20/80 time release delivery system. That means that your child gets 20% of the dose immediately and then 80% throughout the rest of the day. Ironically, because it is only available in a pill that can’t be crushed or opened, the closest medicine to that delivery system is Concerta, with its 22/78 system.

Cotempla XR-ODT is close, with a 25/75 delivery system.

Quillichew ER uses a 30/70 delivery system.

Aptensio XR uses a 40/60 system and some others, like Focalin XR use a 50/50 system.

Why does any of this matter?

If your child was doing great on Quillivant XR and you switched to another medicine using an equivalent dose of methylphenidate, they will be getting that dose delivered to them differently throughout the day. While that might be okay, it could also mean that your child is now starting the day off with either too much medicine (watch for side effects) or is getting too little medicine later (watch for decreased effectiveness). And that will mean some extra fine tuning of your child’s medication until Quillivant XR is available again.

Is your child due for a refill of his Quillivant XR? It’s probably time to look at your alternatives until the shortage is fixed.

What to Know About the Quillivant XR Shortage

Quillivant XR is a long acting form of methylphenidate that is available in a suspension form, so is easy for kids with ADHD to take if they can’t swallow pills, at least it is when there isn’t a shortage.

Remember, that although often underused, it is recommended that behavior therapy be the first treatment for younger, preschool children with ADHD. Both medication and behavior therapy are typically recommended for older children with ADHD.

Other off-label medications for ADHD that are also sometimes used include bupropion (Wellbutrin), tricyclic antidepressants such as desipramine (Norpramin), and imipramine (Tofranil), and modafinil (Provigil or Nuvigil).

Yes, we have come a long way from Dr. Charles Bradley’s first studies of benzedrine (racemic amphetamine) in 1937.

How to Choose ADHD Medication for Your Child

Once you start looking at medication options, the first thing to keep in mind is that there is no one single ADHD medication that is better than others for all kids.

The best ADHD medication is going to be the one that your child will take and which controls your child’s symptoms without side effects (or with minimal side effects) for as long as you need it to, without costing an arm and a leg.

So, do you want an ADHD medication that comes as a chewable pill, a pill or capsule that your child can swallow, a capsule that can be opened and sprinkled on food, a dissolvable tablet (ODT), a liquid, or a patch?

How long do you want it to last? 4, 6, 8, 10, 12 or 15 hours?

Is your child going to take it every day or just on school days?

What ADHD medicines has your child already tried?

Answering those questions will help to narrow down which ADHD medicine might be best for your child.

ADHD Medications

Again, there is really no one best ADHD medicine.

“…stimulant medications are highly effective for most children in reducing core symptoms of ADHD.”

American Academy of Pediatrics ADHD Clinical Practice Guideline

And you don’t even have as many options as you think you do.

While it may seem like there are dozens of medications available to treat ADHD now, most are really just different variations of the same few active ingredients.

And if you don’t have insurance or if you have have a high deductible, you will want to know that those that aren’t yet generic (in bold) are going to be much more expensive than the others:

In general, stimulants are thought to work better than non-stimulants, but again, there isn’t one stimulant that is consistently better than another.

And there isn’t one medication that targets specific symptoms better than another, so you don’t need to look for a specific medication just because your child has the inattentive type of ADHD vs another who is also hyperactive and impulsive.

Deciding Which Medication Is Best for Your Child

Which ever medicine you choose, you typically want to start at a low dose and slowly adjust the dose up or down as necessary based on how well it is working and whether or not your child is having any side effects.

“…more than 70% of children and youth with ADHD respond to one of the stimulant medications at an optimal dose when a systematic trial is used.”

American Academy of Pediatrics ADHD Clinical Practice Guideline

Keep in mind that:

generic, short acting Ritalin (methylphenidate) is often going to be your least expensive option

coupons are often available for newer medications to lower or eliminate your copay, but that doesn’t help you if you don’t have insurance, have a high deductible, or if a medication isn’t covered by your insurance

it often takes a few days for kids to adjust to being on an ADHD medication, so don’t judge them too quickly

it doesn’t take weeks or months for an ADHD medication to work, so don’t wait too long to make adjustments

if your child is having major side effects, don’t just switch medications, be sure to switch the active ingredient too. For example, if a low dose of Metadate CD made your child very irritable and caused trouble sleeping, then switching to Ritalin LA doesn’t make much sense, as they are both time release versions of methylphenidate. Other ADHD that contain methylphenidate as an active ingredient include Aptensio, Concerta, Cotempla XR-ODT, Daytrana, Methylin, QuilliChew ER, and Quillivant XR.

some of the newest medications, like Zenzedi, are really just different forms of Dexedrine, one of the first ADHD medicines.

Mydayis (mixed salts of a single-entity amphetamine) is just Adderall XR, but modified to a three-bead delivery system to make it last longer

Dyanavel XR is similar to Mydayis and Adderall XR, but contains a 3.2 to

1 ratio of d-to l- amphetamine

you can open and sprinkle the contents of Adderall XR, Aptensio XR, Focalin XR, Metadate CD, Ritalin LA, and Vyvanse on applesauce if your child can’t swallow these capsules. The contents of Vyvanse is a powder and will easily dissolve in a small amount of water! These are often less expensive options than a newer chewable, liquid, or dissolvable tablets.

you can not open Concerta and Metadate ER or you will ruin the time release delivery system. They must be swallowed whole.

while there is an authorized generic for Concerta, there are some generic versions that do not have the same therapeutic effect because they do not have the same extended delivery system. Make sure you are getting an authorized Concerta generic.

some extended release ADHD medications simply mimic taking the medication twice a day, giving 50% of the dose in the morning and another 50% later in the day, like Adderall XR, Focalin XR, Metadate ER, Ritalin LA, and Vyvanse

other extended release ADHD medications have different time release schedules. For example, Concerta gives 22% of the dose immediately and then slowly time releases the rest throughout the day. Similarly, Metadate CD releases 30% of the dose immediately and the rest later. Aptensio XR uses a 40/60 delivery system. And Daytrana, the patch, slowly time releases the dose throughout the day. Quillivant XR uses a 20/80 delivery system. QuilliChew ER uses a 30/70 delivery system. And Cotempla XR-ODT tablets use a 25/75 delivery system

although some people start the day with an intermediate or long acting medication to get their child through school and then a short acting medication after school, before doing this, consider increasing the dose of the intermediate or long acting medication to see if it will last longer

non-stimulants are pills that must be swallowed and they typically must be given to your child every day for them to work properly

genetic tests to try and see which medications will work best for your child have not been tested on kids

even if you are only going to be giving your child medication on school days, be sure to give it every single day at first, even weekends, so that you can more easily see what side effects it might be causing. Otherwise, since it could wear off by the time you see your child after school, you might miss uncommon side effects, like if it made him too calm or more irritable.

being able to concentrate and do your work and not getting distracted and talking with your friends all of the time is not a side effect – it is the desirable effect.

Most importantly, know that you can take out a lot of what might seem like guess work if you have a good understanding of how these medications work.

What To Know About Choosing an ADHD Medication

For the great majority of kids with ADHD, one of the many available medications will help to control their symptoms of inattention, hyperactivity, and impulsiveness. Learn how to choose the best one for your child.

Although often underused, it is recommended that behavior therapy be the first treatment for younger, preschool children with ADHD. Both medication and behavior therapy are typically recommended for older children with ADHD.

ADHD Medications

Surprisingly, there is really no one best ADHD medicine. Those that aren’t yet generic (in bold) are going to be much more expensive than the others.

In general, stimulants are thought to work better than non-stimulants, but again, there isn’t one stimulant that is consistently better than another.

Treating Hard to Control ADHD

What do you do when your child’s ADHD treatments aren’t working?

While it is important to “initiate an evaluation for ADHD for any child 4 through 18 years of age who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity,” it is important to remember that not all kids with academic or behavioral problems have ADHD.

So the first thing you should do is confirm that your child really does have ADHD. Is it possible that your child was misdiagnosed and doesn’t have ADHD at all? Or could your child have ADHD and another co-morbid condition, including “emotional or behavioral (eg, anxiety, depressive, oppositional defiant, and conduct disorders), developmental (eg, learning and language disorders or other neurodevelopmental disorders), and physical (eg, tics, sleep apnea) conditions.”

Next, ask yourself these questions and discuss the answers with your pediatrician:

Is your child taking his medicine?

Does your child need behavior management therapy?

Are you not getting your child’s ADHD medicine because of how expensive it is? Ask your pediatrician about a lower cost generic ADHD medicine.

Has there been a sudden worsening of previously well controlled ADHD, which might indicate a problem with bullying, social changes at home, abuse, or depression, etc.?

Are you relying on restrictive diets or other alternative treatments for ADHD that have been proven to not usually work?

Does your child need a different dosage of his current stimulant, either a higher or lower dose?

Is your child’s medication wearing off too soon?

Does your child’s medication take too long to work?

Does your child need to switch to a different stimulant or to a stimulant with a different delivery method?

Does your child need to switch from a long-acting stimulant to a short-acting stimulant?

Does your child need to switch to a non-stimulant, keeping in mind that these are often used in combination with a stimulant and not by themselves.

Do you need to adjust your expectations for what kind of control you can get from even maximal treatment?

Does your pre-teen or teen with ADHD not want to take his medication anymore?

Are side effects keeping your child from taking his ADHD medicine everyday?

Does your child need 504 plan accommodations at school and/or an IEP?

And perhaps most importantly, what is making your child’s ADHD hard to control? Is he just still having some ADHD symptoms or are those lingering ADHD symptoms causing an impairment? If they aren’t causing an impairment, such as poor grades, problems with friends, or getting in trouble at school, etc., then your child’s ADHD may be under better control than you think.

What To Know About Treating Hard to Control ADHD

ADHD can sometimes be hard to control and require more than just a quick prescription for Ritalin or Adderall, including adding behavior therapy, careful monitoring, and special accommodations at school.